In 2003 we developed PALSA, based on the World Health Organisation’s PAL strategy designed to improve the case detection of TB and the management of other common respiratory conditions. The guideline was adapted and tailored to local conditions and national protocols and tested in the Free State province in 2003 [Article Reference]. A large randomised controlled trial [Article Reference] found that PALSA substantially improved the quality of care for respiratory patients, increasing TB case detection by 68%, the provision of inhaled corticosteroids for patients with asthma by 80%, and the appropriate referral of severely ill patients by 120%.

In 2005 the approach was expanded as PALSA PLUS to include counseling and testing for HIV, routine care for HIV clients before and once on ART, prevention of TB and other opportunistic infections, PMTCT, and prevention and treatment of STIs. A second randomised controlled trial [Article Reference] in the Free State found that the educational outreach component improved the provision of cotrimoxazole prophylaxis over and above the intensive training that accompanied the implementation of the Comprehensive Care, Treatment and Management of HIV and AIDS Programme in that province.

The findings from the first randomised trial, the expansion to HIV/AIDS and STIs, and positive feedback from nurses and nurse trainers [Article Reference], prompted the Free State and Western Cape to implement the programme throughout their primary care facilities.

In 2009 the Knowledge Translation Unit was awarded the tender from the National Department of Health to roll out PALSA PLUS in 4 South African TB crisis districts in the Eastern Cape, Gauteng and KwaZulu Natal provinces. At the end of 2009, the president of South Africa called for intensification of efforts in the fight against HIV/AIDS. Consequently early in 2010, the Department of Health actively set about integration of HIV treatment into the primary health care services and increasing accessibility to HIV testing and treatment. This necessitated revision of policies and increase in capacity for health care. The PALSA PLUS guideline for the general management of HIV/AIDS, TB & STIs was revised, including Nurse Initiation and Management of ART (NIMART) to include the policy changes that were instituted in April 2010, and training is currently underway in various stages of roll out in the remaining 7 provinces.

For example, as at the end of November 2010 the unit has trained, mentored and supported over 607 nurse trainers who in turn have trained 9318 nurses in 913 clinics across the nine provinces [see updated training stats].

Funding has been made available for PALSA PLUS from the International Development Research Centre Canada, Free State Department of Health, Western Cape Department of Health, Belgian Technical Fund, National Department of Health, The South African Clothing & Textile Workers Union and the Centre for Disease Control,SA.

See the PALSA PLUS newsletters

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